RC-14-658ami Shores Vill
ilding Departril
.E.2nd Avenue, Miami Shores, Flom
4: (305) 795.2204 Fax: (305) 756.85
TION'S PHONE NUMBER: (305)
BUILDING
PERMIT APPLICATION
03
2
Permit No.
M2 (
Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:&�
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder):0b1^k5 )Qh't` t Cft$ (1iy CIA�C- Phone#: 9 09M
Address:r
City: CO 'a �$� )+ Ali �°'� StateT� Zip33 y�8
Tenant/Lessee Name: Phone#:
Email: V10-%. OAC4CI(cc'4e, A) nn-v,n.1. 61
CONTRACTOR: Company Name: D SAM ar C *4 S f, -LG f) �4 yfaW Phone#: W(0—
Address: -31 ca Al. t,,,/ of 7 T*, X
City: 5,zA /'% i t State: L Zip: 1 V75 1
Qualifier Name: Phone#: l g(' — Z -ttq
State Certification or Registration #: f C.& 16 1 qS 3 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: dw Square/Linear Footage of Work: 10049 5!1 >1'
Type of Work: ❑Addition XAlteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: R 6lDzatloy, C/!' Ad a-cLee '84Ahly&ft 0., a,& 1 a f u ce
Color thru tile:
Submittal Fee
Scanning Fee $
Permit Fee $_
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF
CO/CC $
DBPR $ Bond $.
Technology Fee $
TOTAL FEE NOW DUE $ V l
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence uch posted notice, the
inspection will not beAWroved and a reinspection fee will be charged. /j
Signature Signature ._• a
Owner or Aeent Contractor
The foregoing instrument was acknowledged before me this
day of t , 201, by111 n'���( Jam•
who is p go lly kn„ ow i to me or who has produced
_ As identificaam- nd who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires: -91004
APPROVED BY
MONICA RWIERA
My COMMISSION # EE 022431
EXPIPGc• ne,.,..,,—.,..
8wtded'
The foregoing instrument was acknowledged 6efor'e me this
day of ` % , 20% , by ec�i,�/,;g, e!2�6H
who is p sonally known to me or ho has produced
IffiTcation and who did take an oath.
NOTARY PUBLIC:
Structural Review
(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Clerk
zip
zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence uch posted notice, the
inspection will not beAWroved and a reinspection fee will be charged. /j
Signature Signature ._• a
Owner or Aeent Contractor
The foregoing instrument was acknowledged before me this
day of t , 201, by111 n'���( Jam•
who is p go lly kn„ ow i to me or who has produced
_ As identificaam- nd who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires: -91004
APPROVED BY
MONICA RWIERA
My COMMISSION # EE 022431
EXPIPGc• ne,.,..,,—.,..
8wtded'
The foregoing instrument was acknowledged 6efor'e me this
day of ` % , 20% , by ec�i,�/,;g, e!2�6H
who is p sonally known to me or ho has produced
IffiTcation and who did take an oath.
NOTARY PUBLIC:
Structural Review
(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Clerk
ki
u
April 30, 2014
Miami Shores Village
Building Department
10050 NE 2nd Avenue
Miami Shores, Florida 33138
Responses to Building Comments
Permit Number: RC -4-14-658
Address: 1165 NE 91 st Terrace
Buildina Critique:
'y 1/.Sheet AC -1 has been revised by the mechanical engineer to show the R -values of roof
e,, and wall insulation;
Sheet A-1 has been clarified by hand by the Architect of Record;
✓" 3. Sheet A-2 has been clarified by hand by the Architect of Record;
. 4. (2) new crawl space vents have been added to sheet A-2, see new note 33
Sincerely,
Victor J. Bruce A.I.A., LEED R AP
Vice President & Architect
AR -0017103
A&I associates, inc.
70 NE 101" Street
Miami Shores, Florida 33138
telephone 305-310-5030
fax 1-877-408-8280
email vbruceCr t.ii cassodcifes f,e?
Miami Shores Village
7 uilding Department
SVA
(NSPECTION
50 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
E!(BUILDING ❑ ELECTRIC ❑ ROOFING
i
JUL 14 2014
w�
FBC 20
Master Permit No. '�(- — (�5—K
Sub Permit No.
❑ REVISION ❑ EXTENSION [:]RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
Tei+,.
City: Miami Shores County: Miami Dade Zip: 3'? 138_
Folio/Parcel#:
Is the Building Historically Designated: Yes NO >(I
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): C11",' � / yk t7 -e r V-< Phone#:
Address: 11 (,e S N• C CO T-er .
City:�qStater Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 60�/Uc4rA C/ Gv IE Phone#:
Address: (g(j N, („/ Of 7 t t,,
City: 5(44&:k State: ISL_ Zip: )S/
Qualifier Name: (( d ."i:5 -Q A Phone#: (/ �Sr
State Certification or Registration #: r G G i 5 ( C15 -3 ( Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: R t /'/v r{l/ o�►�/
$
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $ _
Technology Fee $_
Structural Reviews
(Revised02/24/2014)
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Training/Education Fee $
'O/Cr $'
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appro a reinspection fee will be charged.
S
Signature Signature
gnature
OWNER or AGENT CONTRACTOR
The fore oing instrumentw ack owledged before m this The foregoing instrum t was acknowledged before me this
day of 20 , by day of 20 by
i
who is personally known to who is personally known to
ma,or _why has produced as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOT
Sign
Prirr
Seal
****a
A
(Revised02/24/2014)
Certificate of Completion
Miami Shores Village
10050 NE 2 Ave, Miami Shores FI, 33138
Tel: 305-795-2204 Fax: 305-756-8972
Building Inspection Department
This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in
compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following:
Permit Type RESIDENTIAL CONSTRUCTION
Bldg. Permit No. RC -4-14-658
Owner CHRISTOPHER CARVER
Contractor
DENMAR CONSTRUCTION GROUP
Subdivision/Project
NONE
Date Issued
03/13/2015
Occupancy
Construction Type
V -B
Load
4
Square Footage
1000
Ocpceupancy
Ty
SINGLE FAMILIY
Description of
RELOCATE MASTER BATH AND
Applicable
Work
INTERIOR RENOVATION
Code
2010 FLORIDA BUILDING
Location
1165 NE 91 TER
Miami Shores FL 33138
Flood Zone AE
F.F.E 6.50
J,31151,1
Building Officials A.. Ismael Naranjo,
Not Transferable
POST IN A CONSPICUOUS PLACE
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-229659 Permit Number: RC -4-14-658
Scheduled Inspection Date: March 11, 2015 Permit Type: Residential Construction
Inspector: Rodriguez, Jorge
Owner: CARVER, CHRISTOPHER AND
Job Address: 1165 NE 91 Terrace
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: DENMAR CONSTRUCTION GROUP
comments
Inspection Type: Final Building
Work Classification: Alteration
Phone Number
Parcel Number 1132050010180
RELOCATION OF MASTER BATHROOM & INTERIOR ------
REFINISHING.
_____REFINISHING. INSPECTOR COMMENTS False
Phone: (954)372-6623
March 10, 2015 For Inspections please call: (305)762-4949 Page 19 of 29
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
March 10, 2015 For Inspections please call: (305)762-4949 Page 19 of 29
ip,
i
JX T
T
INPPCTION,
,.
ZONING
I. .
INSPE4 1 N
IDAT
Foundation
i'Z Final
Sternwall
N M
Slab
W r ice
Columns 1`st Lift
Columns 2nd Lift
T taut
, J
1
Tie Beam
its
Truss/Rafters
Tank ;.
Roof SheathingSewer
-UR
Bucks
oof ins
Windows/Doots
Gas
Interior Ftami
D
i .
L at►k.
Insulation .+?'
rale
Well t
CeilingGrid
O ei ra
i.Wrl'
D air
Firewall
P�SoI. ndin '
it
Wire Lath
Pool Wet Niche!(
. .
Pool Steel
Lind . rd ;
706 -946 -Ml P.1
Broward Insulation. Inc 954-486-5993 P.1
BUILDING PERMfT*.
INSULATION INSTALLATION CERTIFICATE
Prwany Address.
ctli-S4aZB
ZP
Lelial Desci"=.TCwrstrip
Range -secfim S-ubdhftkn
8-fockffilwW Lot
The undersigniad hereby CWNW 111101: KmAntion has been m--da-W in the above-describW
reciukenaft for R - Val afthefts FnsrWFffx%enLyCode, asfdjoW
Property W Most the mfr vin
1- Exterior CBS welts have been insiulaw with (Cheat one from VM ID a
0
Spray an Cellulose
thidmess of hCha&, which thickness, acccremj
0
C
Fjx� eatti
Rock Wool Batts
to 1
)W-
AluminLim Foil
0
polyur pane
Vdl Vidd an 'W Value Of M -bags per square feet
0
0
Poq
Oche-
Exterior (Frame VW19) haw been wouldedw9h (Check one from the column at
0
Spray on Cellulose
right) to a thidmess of Inches. which thickness, according
0 0
Fibergl
Rock ass Batts
Wool Batts
to
E3
Numinurn Foii
0
Polyurethane
will "V yield an 'R' value of -
0
Other
2 Callings (level" have been insulated with (Cheat one ftrr, the column to the
Fiberglass 8 lednicals
fight) tDathickness of J_,;_kichesmftchthickness according
0
Fiberglass Loose Fill
Rock Wool Blankets
to � . I t f. , vA-J yveld an'fr value
0
Rock WWI Loose Fill
0
Cellulose Locr-10 FM
Of0
at bags W thousand sqjam beet
Other
coning (valtedcathedral) hwm - kisubted with (Check am from the
E3
0
Mass OLankeft
Fiberglass Lome FBI
C011.11frin t13 the 0911111 to 3 2111CIM988 of inchm vh*M Vilckriess.
0
Rock Wool Blankaft
_
8=01(b to viN yield an'fr value
0
0
Rock Wool Loose Fill
Cellulose Lome Fill
El
Oftr
Of
3 fritaiiar Khaa Walls have been iramdafAd vvilh a Mineral Fjbw Batt to a thicknow of
vrmhm which
thfckneaa` accordhM to MA"UFAMItER -vwMVtddan'Frvakwaf
4- G=P P8rbWn Waft OfWnftoned RWQ area have tim which
thidMe". nocom" to %VAWFAC`nXEP --- %vrl ylefdan *fr varve of
5. The following areas twoe not been kwgatect
Br.
Date.
0 -UMM
LOCI ,t
--, .),�/7 1
MOM
PAULPIE M 9JMUY
NM&fy Pok - State Of Flof id a
My Comm. Expires Oct 2, 2017
Commission # FF 05=11
Mission: Rick Scott
To protect, promote & improve the health Governor
of all people in Florida through integrated
state, county & community efforts. FicinaaJohn H. Armstrong, MD, FACS
HCJI! LTH State Surgeon General & Secretary
Vision: To be the Healthiest State in the Nation
February 26, 2014
Denmar Construction Group
3180 NW 97 Way
Fort Lauderdale, FL 33351
RE: Modification to a Single Family Residence - No Bedroom Addition
Application Document Number: AP1131322
Centrax Permit Number: 13 -SC -1514037
1165 NE 91 Terrace
Miami, FL 33138
Lot: 20 Block: 1 Subdivision:
Dear Applicant,
This will acknowledge receipt of a floor plan and site plan on 01/07/2014 for the use of the existing
onsite sewage treatment and disposal system located on the above referenced property. Interior
remodelation with same # of bedrooms.
No objection letter was issued by C. icaza on 02126114.
This office has reviewed and verified the floor plan and site plan you submitted, for the proposed
remodeling addition or modification to your single-family home. Based on the information you
provided, the Health Department concludes that the proposed remodeling addition or modification is
not adding a bedroom and that it does not appear to cover any part of the existing system or
encroach on the required setback or unobstructed area. No existing system inspection or evaluation
and assessment, or modification, replacement, or upgrade authorization is required.
Because an inspection or evaluation of the existing septic system was not conducted, the Department
cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use.
You may request a voluntary inspection and assessment of your system from a licensed septic tank
contractor or plumber, or a person certified under section 381.0101, Florida Statutes.
If you have any questions, please call our office at (305) 623-3500.
Sincer ,
i
(i
Carl aza
Engine r III
Department of Health in Dade County
Florida Department of Health www.FloridasHenith.com
in Dade County - • , Florida TWITTER:HeafthyFLA
PHONE: (305) 623-3500 FACEBOOK:FtDepartmentofHealth
YOUTUBE: ftdoh
March 5, 2015
Miami Shores Village
Building Department
10050 NE 2nd Avenue
Miami Shores, Florida 33138
Final Inwection Leer
Permit Number: RC -4-14-658
Address: 1165 NE 91 st Terrace
Building Department,
I, Victor I Bruce and Architect of Record, having performed visual observations
of the project and performed and approved the required masonry inspection at
the renovation, hereby attest to the best of my knowledge, belief, and
professional judgment, the structural and envelope components of the above
referenced renovation are in compliance with the approved plans.
I also attest that to the best of my knowledge, belief, and professional judgment,
the approved permit plans represent the as built condition of the structural
envelope component of the said structure.
Please contact me at 305.310.5030 if you have any questions and/or comments
erely,
Victor J. Bruce A.I.A.,
Architect
AR -0017103
370 NE i0V'Street
Miami Shores, Florida 33138
teiephone 305-310-5030
fax 1-877-408-8280
email vbruce4-ai-associates.nei
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MAAAGEMEN7AGENCY ELEVATION CERTIFICATE
NaOMS
N0, 1660-00081660-0008tional Flood lnsu>~ance Program itl Portant: RiAd the illStru coons on pages -;9, - Explr�IDTi i9ate:.luiyr 31, 2015 --
SECTION A - PROPERTY INFORMATIONF+ci131NsiiR,6,niCE t;l30MPA1!Y USE
Al. Buiidi Owner's Nam
CHR TOPHER TU 14-678 Palicyl~lurri#jer
A2. Building Street Address (including P,pf , Nu
Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAjD mber,
1165 N.E. 91 TERRACE -
MIAMI SHORES FLORD4A 3i13Crde
A3- PrnnarFvflacrrinff „n m
- .__._, . o . , o..�, �,uu�uciI 1-ayai ucsuupuun, eu:.l
E35 OF LOT 20 & W401___0_ T -O'T 1 'T nr+v i v "D n ,-, A,.,? 1 L I- "
H4. ounoing use e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitudell-ongiiude:.Let. N25°51' 35.681ong, W80° 10' 25.85" Horizontal Datum: 0 NAD 1927 NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
AT Building Diagram Number 8 . `
A8: For a building with a crawlspace or enclosur s
A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(S) 2 , 293 sq ft a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the crawlspace
or enclosures)12 b) Number of permanent flood openings in the ched garage
within 1.0 foot above adjacent grade within 1.0 Toot above adjacent grade N /
c) Tatal�iet area of flood openings in AB.b �,2 sq tri c) Total net area of flood openings in A9.b N7A- sin
d) Engineered flood openings? q
Yes .No d) Engineered flood openings? 0 Yes No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community dame & Community Number B2. County dame B3. State
VILLAGE OF MIAMI SHORES 1206 ? 'MTAUT_n An
84. Map/Panel Number B5. Suffix B6. FIRM index Date B7. FiRM Panel B8. Flood 89. Bad Floodlelevation(s) (Zone
12086CO306 L 9/11/09 Effective/RevisedDate Zone(s) AO, use base flood depth)
9/11/09 AE 8.00'
810- indicate tAe snurrp of tha Roee r� �_.:_� _ _
-
F1S Profile FIRM' Q CommunityDetermined. Other/Source:
Bl 1. Indicate elevation datum used for BFE in Item B9: 0 NGVD,182s, a NAVD 1988 ) Other/Source-
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date: N/A
0 Yes No
a CBRS OPA '
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Ci.- Building elevations are based on; Construction Drawings' 0 Building Under Construction" ( Finished Construction
*Anew Elevation Certificate will be required when
construction of the building is complete.
C2. Elevations - Zones Al A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, ARIA, ARAE, AR/A1 A30, AR/AH, AR/AO. Complete Items C2.e-h
below according to the building diagram specified in item
A7. In Puerto Rico only, enter meters.
Benchmark Utilized: B-62
Vertical Datum: AiO![3 9929
Indicate eievation datum used forthe elevations in items a) through h) below. 0 N13VD 11329. %7.-NAi/D1988 0 other/So=6:
Datum used for building elevations must be the. same as that used for the BFE.
- Check the measurement used.
a) Top of bottom* floor (including basement, craWISP ace, or enclosure floor) 6 .50 21 feet meters
b) Top of the next higher floor 8 .O1 0 feet 0,meters
c) Bottom of the lowest horizontal structural member (V Zones only) N A .2] feet #7 meters
d) Attached garage (top of slab) N/A . feet meters
,)�j
e) Lowest elevation of machinery or equipment servicing the building 6 .35 feet [3 meters
(Describe type of equipment and location in Comments)
1) Lowest adjacent (finished) grade next to building (LAG) 6.05 feet meters
g) Highest adjacent (finished) grade next -to building (HAG) :::i:.T0— 0 feet EJ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A . N feet 0 rn iers
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certifiication is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. 1 certify that the information on this Certificate
represents my best efforts to interpretthe data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 9001.
0 Check here if comments are provided on back of form. Were latitude and longitude in Section A,provided by a
8b-1 9.114
Check here if attachments. licensed land surveyor? Yes t3 No
P f �24
Certifier's Name Adis N. unez License Number 5924
Title Reg- Land Sury6ybr Company Name Blanco Surveyors, Inc.
Address 555 N re Dr.City Miami Beach State FL ZIP Code 33141
Signature Date 8 / 19 / 14 Telephone 305-865-1200
JQN Utlli;I IFICATEpaga 2
IMPORTANT: in these spaces, copy the corresponding information from Section A. ;
Building Street Address ((indI �q FOR Wsuk cE COMPANY, ME
1165 N ..E .. 9 I TERRAL�' Unit, Suite, and/or Bldg. No.) or P:O: Route and Bex No:
City.
PollyN>Jrnbrrr�
MIAMI Si30RES State ZIP Cd
FLORIDe ,
4
FLORIDA'.- 3313ti fAlWanY"CXumber
SECTION D-. SURVEYOR.. ENGINEER, OR ARCHITECT CERTIFICATION (CQNT1Ni1ER}
Copy both sides of this Elevation Certificate for (1) communityofficia1 (2) insurance agenticompany, and (3) building owner.
Comments LATITUDE &LONGITUDE OBTAINED BY GOOGLE:'
CROWN OF 'T E ROAD ELEVATION: -5.751.,_)N CENZERLINE ON:;CENTER OF. I{OAD.,
BM#- B-6 -.:,. ...:.1,OGATOR. 3250 5.:-- ELEV: 8.6-7'
Signature : ;
Date
Lz
8J.1.9/14
SECTION E -BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A T
For Zone AO and A (without BFE), complete Items E1 E5. If the Certificate is intended to support a LOMA of LOMR-F request, coni late s HO
BFE)
and -C.* For Items E1 E4, use natural grade, rf available.. Check the measurement used. In Puerto Rico.onty, enterzne#ars P actions A, B,
E1. Provide elevation information for ttie fotfowing and check the`apprflpriaie bsaxes to show whetfiier the elevabon.Is.above.or. below the highest ad'acent
grade,(HAG) and the lowest adjacent grade:(LAG)•-; > -
1 11,
a) TOP. -
op of botiorn floor (including basement crawlspace; or enclosure) is
b) Top of bottom floor (including basement, crawlspace, oz.enclosure) Is
f meters above or eat [ below the 1-14G
E2. For Building Diagrams 6-g yuith pe>manentfloo. d openings provided.in`Sechon A items B a pe(s{�ages 8 9. obi 1 strucfionsihe next hi hsr floor
ove oro belowtheLAG.
(elevation C2.b in the diagrams) of the building is
E3. Attached garage (top of slab) is Q feet'. LI meters j� above or..13 below the: HAG.
E2 feet Q meters 0 above or `j= j below the iiAG.
E4 Top of platfoml of.machinery and/or equipment seniicin the buildin is
.E5 Zone AO only If no flood de g g feet 13 meters =j above or Q below the 1dE+,G.
depth number is available, is the top of the bottom floor elevated in accordance wrin the community s floodplain management
arrlinance7_''�J Yes Q No llnkriawn. T#te iocai of ictal must
cetttiy this information in Section G.
SECTION F -PROPERTY OWNER (OR OWNER'S .REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A B, and E
for Zone A (wifliout a FEMA Issued or community issued BFE)
or Zone AO must sign here. The statements to Sections A, B; and E are correct to the`bes# a# my. knowledge:
Property P nY Owner's or Owner's Authorized Representative's Name
Address
Sime
ZIP Code
Signature ._.... - .
Date Telephone
Comments
Check here if. attachments.
SECTION O COMMUNITY INFORMATION (OPTIONAL) .
-he local official who is authorized by taw or ordinance to administer the community's floodplain management ordinance can complete Sections A, B C (or and G
I this Elevation Certificate. Complete the applicable items) and sign below. Check the measurement used in Items .G8 -G10. In Pueiio.Rico only, enter meters..
31. Q The jnfoization'ia Section C was taken from other documentation that bas'bean signed and sealed by a licensed sui*ro.r, engineer, or architect who
is authorized by law to certify elevation lrrfor-oration (Indicate the source and date of the elevation data in the Comments area below.)
'2• A community official completed Section E for a ding located in Zone A (without a FEMAassued or.communiiy-issued $FE) or Zone A0. .
33- The following information (Items Gel -G10
u
) is provided for community floodplain management Purposes.:
G4. Permit Number G5. Date Permit issued
G6. Date Certificate Of Compliance/Occupancy, Issued.
7. This petrriit has been issued for. 0 New Construction Q: Substantial Improvement
8. Elevation of as -built lowest floor (including basement) of the building:
9. BFE or {in Zone AO) depth of flooding atthe b»ilding site: i feet- - j
I feet meters Datum
Q meters Datum
10. Community's design flood elevation -
fl feet } meters Datum
-ocalOfficial's Name
Title .
Iommunity Name
Telephone
Signature
Date
:omments
D Check here if attachments.